Abstract
Background
Central venous access devices (CVAD) are associated with central line associated bloodstream infection (CLABSI) and venous thromboembolism (VTE). We identified trends in non-intensive care unit (ICU) CVAD utilization, described complication rates, and compared resources between low and high CVAD sites.
Methods
We combined data from the Pediatric Health Information System (PHIS) database and surveys from included hospitals. We analyzed 10-year trends in CVAD encounters for non-ICU children between 01/2012-12/2021 and described variation and complication rates between 01/2017-12/2021. Using Fisher’s exact test, we compared resources between low and high CVAD users.
Results
CVAD use decreased from 6.3% to 3.8% of hospitalizations over 10 years. From 2017–2021, 67,830 encounters with CVAD were identified. Median age was 7 (IQR 2–13) years; 46% were female. Significant variation in CVAD utilization exists (range 1.4–16.9%). Rates of CLABSI and VTE were 4.0% and 3.4%, respectively. Survey responses from 33/41 (80%) hospitals showed 91% had vascular access teams, 30% used vascular access selection guides, and 70% used midline/long peripheral catheters. Low CVAD users were more likely to have a team guiding device selection (100% vs 43%, p = 0.026).
Conclusions
CVAD utilization decreased over time. Significant variation in CVAD use remains and may be associated with hospital resources.
Impact
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Central venous access device (CVAD) use outside of the ICU is trending down; however, significant variation exists between institutions.
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Children with CVADs hospitalized on the acute care units had a CLABSI rate of 4% and VTE rate of 3.4%.
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91% of surveyed institutions have a vascular access team; however, the services provided vary between institutions.
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Even though 70% of the surveyed institutions have the ability to place midline/long peripheral catheters, the majority use these catheters less than a few times per month.
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Institutions with low CVAD use are more likely to have a vascular access team that guides device selection.
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Data availability
The dataset analyzed during this study are available from the Pediatric Health Information System (PHIS), but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission from PHIS.
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Funding
A.G.B. work on this study was in part completed while participating in a 2-year Clinical Research Scholar Program funded by a training grant (UL1 TR001436).
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A.G.B. conceptualized and designed the study, led data summary, analysis and interpretation; drafted and revised the manuscript. C.B. contributed to the design of the study, performed PHIS data retrieval and harmonization, participated in data analysis and interpretation, critically reviewed and revised the manuscript. T.L. and E.R.C., K.P. contributed to the design of the study, participated in data analysis and interpretation, critically reviewed and revised the manuscript. A.Y.P. and M.L. contributed to study design, performed the quantitative statistical analysis, reviewed and revised the manuscript. K.E.F., A.J.U. and D.C.B. contributed to the conceptualization and the study design, reviewed the data analysis plan and data output, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted.
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Competing interests
Kathryn Flynn has received consultancy funding from Inhibikase, Pfizer, and Novartis unrelated to this work. Amanda Ullman’s employer (UQ) has received investigator-initiated research grants from vascular access product manufacturers (3 M, Becton Dickinson, Medline) on behalf of her research, unrelated to the submitted project. David Brousseau receives consultancy funding from CSL Behring unrelated to this work. The remaining authors have no conflicts of interest to disclose.
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Burek, A.G., Bumgardner, C., Liljestrom, T. et al. Use of central venous access devices outside of the pediatric intensive care units. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03337-7
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DOI: https://doi.org/10.1038/s41390-024-03337-7
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